Quality Improvement

The task of improving quality is a demanding job. It requires focusing on clients, using data, working collaboratively with other team members, and maintaining an overarching view of the health system in which we work. Benchmarking is a process for finding, adapting, and applying best practices. [adapted from author]

This presentation was part of the 2006 Global Health Mini-University. This session highlights the need for greater investments in quality improvement in the private health sector. It also provides an overview of promising approaches and offers a detailed discussion of emerging accreditation models and other recognition systems for the private sector. [publisher’s description]


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Applying the lessons of the quality movement in industry and medicine, programs have created approaches that suit reproductive health care in developing countries. While still in the early stages, these efforts suggest some important principles: clients come first; quality design, quality control, quality improvement

In Senegal, traditional supervision often focuses more on collection of service statistics than on evaluation of service quality. This approach yields limited information on quality of care and does little to improve providers’ competence. In response to this challenge, Management Sciences for Health (MSH) has implemented a program of formative supervision. This multifaceted, problem-solving approach collects data on quality of care, improves technical competence, and engages the community in improving reproductive health care. [abstract]

This guidance was developed to help staff of the ACQUIRE Project understand and explain to counterparts and field partners the improvement approaches and tools used by ACQUIRE. ACQUIRE brings together partners with proven, effective approaches to improving provider performance and the quality of services and to mobilizing communities to drive improvements in health care: performance improvement (PI), quality improvement (QI), and participatory learning and action (PLA). These approaches and tools can be used alone or in a complementary manner, depending on the situation and on the program level being addressed.

The methodology for improving quality in healthcare has evolved rapidly over the past decade. This has come about as a result of several factors: the large number of field experiences that have taken place in many countries worldwide and in a variety of different areas and specialities in healthcare delivery; the increasing complexity of healthcare delivery and with that the emerging new needs for efficient and cost-effective care; the increased expectations of our customers; and lastly, the advances in our knowledge on improvement, management, and clinical practice. This monograph represents an update on quality improvement methodology, which incorporates the most recent thinking on how to implement improvement.

Health systems in industrialized countries are having success with new approaches for evaluating and improving care delivered by clinicians in ambulatory care settings. Described herein is a program which awards recognition to individual physicians or physician groups who deliver high-quality, cost-effective care. [from author’s description]

One of the most important steps in the Performance Improvement Approach is the performance needs assessment (PNA). The PNA focuses on understanding the environment in which service providers work, i.e. the different systems within an organization that affect their performance, as well as the client and community perspectives which influence their family planning access. The performance factors, or those elements that providers need to be able to perform well, are the framework that guides the PI approach and what the PNA is geared to capture. [author’s description]

This is a QI package for the private sector that includes a review of service statistics, accompanying a QI self-assessment tool for midwives to identify quality issues, and a linked action plan for midwives and supervisors to help solve issues the QI tool identifies. [publisher’s description]

PROQUALI is a comprehensive, coordinated and innovative reproductive health (RH) service performance and quality improvement accreditation model funded by USAID. PROQUALI was developed to improve performance and quality and increase access to RH services at the primary healthcare level in northeastern Brazil. The training and technical assistance activities of the three previously independent CAs were integrated and applied during PROQUALI to help demonstration sites achieve state-approved RH service quality standards and accreditation. During the pilot demonstration phase, Phase I, the accreditation model was developed and field-tested in five primary health clinics in the states of Bahia and Cear

In addition to QA and performance improvement, this issue focuses on accreditation in South Africa, QI teams in Guatemala, identifying root causes, increasing compliance with standards, and community-based problem solving. [publisher’s description]

The purpose of this newly revised manual and accompanying toolbook is to assist health care providers working in emergency obstetric care (EmOC) settings to improve the quality of services within their facility. With whatever resources are at hand, quality improvement (QI) processes can help staff change and improve practices and conditions and, in so doing, have a significant impact on pregnancy outcomes. [publisher’s description]

This fact sheet highlights approaches to improving quality of care that can be rapidly implemented, over months rather than years, without great cost. The author writes that better quality can improve health much quicker than other drivers of health, such as economic growth, educational advancement, or new technology. [adapted from introduction]

This user’s guide contains materials needed to design and implement the Quick Investigation of Quality (QIQ) in a given country. QIQ refers to the set of three related data collection instruments designed to monitor 25 indicators of quality of care in clinic-based family planning programs. This volume includes an overview of the QIQ (including objectives, short list of indicators, and methodological and ethical issues), guidelines for sampling and training of field personnel, instruments and guidelines for data collection and summary results from short list of indicators (tabular and graphic forms).

This case study describes how healthcare providers in Nicaragua worked together to improve the quality of obstetric care at their health centers and posts. They began by measuring the extent to which staff performed according to standards. Once aware of the quality gaps, they formed QI teams and used rapid team problem solving to implement quality improvements so that healthcare providers could perfom according to obstetric standards. Continuous monitoring shows their success in meeting the standards and improving health outcomes. [author’s description]